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Benefits of Bariatric Surgery in Adolescents Persist After 2 Years: Presented at AHA

By Ed Susman

ORLANDO, Fla -- November 20, 2009 -- Beneficial changes in heart structure are observed in adolescents as early as 6 months after undergoing bariatric surgery, and benefits persist for up to at least 2 years, researchers said here at the American Heart Association (AHA) Scientific Sessions 2009.

In a study, adolescents lost a mean of 50 kg (110 lbs), and the weight loss showed up in imaging of their hearts, according to Holly Ippisch, MD, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

"Increased cardiac risk factors are present in morbidly obese adolescents but can improve rapidly, within 6 months, following profound weight loss," said Dr. Ippisch during an oral presentation on November 17. "These improvements persist for at least 2 years following profound weight loss."

Dr. Ippisch and colleagues followed 83 children (63 girls, 20 boys) who, at the time of surgery, had a mean body mass index (BMI) of 58. After 6 months, their BMI decreased to 41, and after 2 years their mean BMI was 38. Children were aged 13 to 19 years.

"After the initial weight loss, their weight has appeared to plateau," Dr. Ippisch said.

When the children underwent echocardiograms at 6 months, 1 year, and 2 years, the improvements initially seen remained for heart thickness. The mean preoperative left ventricular mass was 51 g/m2.7 -- a level considered to put adults at high risk of coronary events. At 6 months, the left ventricular mass had declined to 40 g/m2.7, a decrease that was statistically significant (P < .05), Dr. Ippisch said.

Heart diastolic function also improved similarly, and statistically, she said. "Although heart thickness and the ability of the heart to relax at 2 years is significantly improved compared with preoperation status, it is still abnormal by paediatric criteria," she said.

Adolescents are eligible for bariatric surgery at the Cincinnati Children's Medical Center if they have a BMI of at least 40 and have additional comorbid conditions. They also must have failed to respond to attempts at supervised weight loss. The adolescents also must be physiologically mature or nearly mature. The girls have to agree to avoid pregnancy for at least 1 year after surgery. The adolescents also have to show assurance that they can comply with preoperative and postoperation nutritional requirements.

The average age of adolescents in the trial was 16.9 years, 86% were Caucasian, and their average weight was 166 kg. After 2 years the mean weight loss was 52 kg, which translated to 35% of their original body weight.

[Presentation title: Do Acute Improvements in LV Mass and Diastolic Function Following Adolescent Bariatric Surgery Persist at Two Years Post-op? Abstract 1303]

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